Risks flagged in India's fertility
tourism By Neeta Lal
The revolutionary in vitro fertilization
(IVF) technique that has given the world about
five million new people in the 34 years since the
birth the world's first test tube baby, Louise
Brown, continues to court controversy in India.
Earlier this month, Bombay High Court
chastised the Maharashtra state police for being
lackadaisical in investigating the circumstances
that led to the death of 17-year-old Sushma Pandey
shortly after she donated her ovum at a suburban
Mumbai fertility clinic two years ago.
The
process of egg donation - or assisted reproduction
- involves the donor providing eggs, ova or
oocytes for fertilization in a laboratory after
being injected with stimulating hormones. Apart
from the blood group and
physical fitness, height, weight, educational
qualifications and professions are all recorded.
According to the Indian Council of Medical
Research (ICMR) guidelines, it is mandatory to
maintain a gap of at least three months between
donations.
Apparently in Sushma's case,
almost all the ICMR guidelines were blatantly
violated. While an egg donor has to be between 21
and 35 years of age, Sushma was barely 17 she
donated her eggs without her parents' knowledge.
And while she made donations thrice in 18 months
an obligatory gap of three months between egg
donations was ignored.
What rankles most,
say activists, is that the girl was not
remunerated by the fertility clinic, the salient
reason why poor women agree to such highly
invasive medical procedures. In other words, the
clinic simply harvested Sushma's eggs without
compensating her and then went on to commercially
profit from them. Reportedly, the teen was
promised $ 550 for each donated ovum.
"If
Sushma had donated the ovum thrice, she should
have been paid 75,000 rupees [US$1,600]. But we
have not received a paisa [cent] of the money she
earned," the girl's mother told an Indian
newspaper.
In the second such tragedy,
Premila Vaghela, 30, who had rented out her womb
to a US couple, died this May in the eighth month
of a surrogate pregnancy reportedly due to
negligence at a clinic in Ahmedabad in western
Gujarat. Though Premila managed to deliver her
surrogate child, her own two young children are
now motherless.
Both episodes highlight
the grey area in which "assisted reproductive
clinics" (ART) continue operate in the country's
US$500 million fertility tourism industry. They
also underscore the deficiency of laws to check
malpractices.
Acknowledging this, ICMR
said in a report last year that "Most of the new
technologies aimed at taking care of infertility
involve handling of the gamete - spermatozoa or
the ooctye - outside the body ... These
technologies not only require expertise, but also
open up many avenues for unethical practices that
can affect adversely the recipient of the
treatment, medically, socially and legally."
The report added that "The last 20-odd
years have seen an exponential growth of
infertility clinics that use techniques. As of
today, anyone can open infertility or ART clinic;
no permission is required to do so. There has
been, consequently, a mushrooming of such clinics
around the country. In the public interest
therefore, it has become important to regulate the
functioning of such clinics to ensure that the
services provided are ethical and that the
medical, social and legal rights of all those
concerned are protected."
ICMR is setting
up a national registry of assisted reproductive
technology clinics. Until such a registry becomes
operational, experts advocate that the Indian
parliament clear a path-breaking ART Bill, 2010,
which has been stuck in a legislative log jam. The
proposed Bill seeks to put in place several
important provisions to protect the rights of
surrogates.
The pending legislation
clearly states that a woman acting as surrogate
mother in India cannot be less than 21 years or
over 35 years and that she cannot give more than
five live births, including her own children.
There are safety nets that the Bill seeks to build
for the surrogates - they should not undergo
embryo transfer more than three times for the same
couple and no ART bank or clinic can send an
Indian citizen for surrogacy abroad. Strict
confidentiality, according to the proposed bill,
also needs to be maintained about the donor's
identity.
Most doctors concede the need
for a legal framework for the industry, although
some feel it is unfair to tarnish all fertility
clinics with the same brush because good ones are
indeed a boon to childless couples.
"Surrogacy is one of the well-accepted
concepts of assisted reproduction," said renowned
IVF expert Dr Indira Hinduja, who gave the country
its first test tube babies in the 80s, told this
correspondent earlier. "It benefits patients who
can't conceive or carry a pregnancy to term. Such
people can take the help of surrogates to carry
their child in the uterus and then hand it over to
the genetic parents post delivery."
Demand
from childless couples around the world for Indian
surrogate mothers has turned "surrogacy tourism"
into a fast-growing business. Driving the demand
are India's advantages are laws that are less
restrictive than elsewhere, a lack of ART
regulation, the easy availability of surrogate
mothers and medical procedures that cost a
fraction of what they do in the West.
According to the private Indian Society
for Assisted Reproduction (ISAR), there are more
than 600 IVF clinics in the country providing an
estimated 60,000 assisted reproductive treatments
a year. While the government legalized commercial
surrogacy in 2002, the only code governing
surrogacy transactions in the country is a
126-page document issued by ICMR in 2005, which
lays down the National Guidelines for
Accreditation, Supervision and Regulation of ART
Clinics in India.
The guidelines are
legally non-binding, as they have not yet been
ratified by the Indian Parliament. Besides, the
ICMR rules are ambiguous about vital issues like
the rights of the surrogate, the minimum age of
the surrogate, details about the contracts,
informed consent and adoption requirements.
What also needs to be brought under the
law's ambit, say experts, is clarity on the issue
of legal parentage. "Most childless couples spend
whopping sums of money on airfare and surrogacy
contracts only to be told at the last minute that
they can't take their baby out of the country till
cumbersome paperwork is completed," says Dr Anita
Palwal, a Delhi-based gynecologist-obstetrician.
Palwal recounts the case of Manji Yamada,
the daughter of a Japanese couple who was born in
Anand through a surrogacy agreement in 2010.
Manji's parents were divorced midway through the
surrogacy agreement and her Japan-based mother
then refused to accompany the father to pick up
the newborn from India. Indian laws wouldn't allow
the baby to leave the country unless accompanied
by her mother. Finally, Manji's paternal
grandmother had to step in to take her back to
Japan.
Another disconcerting area, say
activists and bio-ethicists, are the rights of the
infertile couple. "For instance," said Vrinda
Vassan, an activist volunteer for Bachpan, a
pan-India children's rights organization, "there
must be a mechanism to assure that the donor's
unused harvested eggs or embryos are not sold by
the fertility clinics to other couples for profit.
The misuse of a surrogate child for purposes of
terrorism, prostitution or unethical genetic
engineering research also needs looking into."
Increasingly, whimsies are also creeping
into the business. A few fertility clinics in
central Bihar's capital Patna, for instance, are
getting cases of local childless couples who nag
the hospital staff about the caste of the sperm or
egg donor before they sign on the dotted line.
"This makes a mockery of the entire IVF process.
The focus should always be on the "quality" of
sperm and not the trivia," said Dr Palwal.
Experts agree that while the proposed ART
Bill won't be a panacea for all the ills, it will
at least sensitize the stakeholders about their
rights while acting as a deterrent for
unscrupulous merchants of the trade.
Neeta Lal is a widely published
writer/commentator who contributes to many reputed
national and international print and Internet
publications.
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